Predicting Treatment Outcomes, Attrition, and Enrolment Suitability in Mindfulness-integrated Cognitive Behavior Therapy: Machine Learning and Survival Analyses

Mindfulness-integrated Cognitive Behavior Therapy (MiCBT) produced large reductions in stress and increases in equanimity among 326 adults assessed at two psychology clinics. More severe depression and PTSD diagnoses predicted faster distress reduction, while PTSD and ADHD predicted greater life satisfaction gains. Younger age, lower baseline life satisfaction, and personality disorder diagnosis predicted lower treatment retention. Prior meditation experience increased the likelihood of enrolling in MiCBT but did not affect retention, whereas ADHD diagnosis predicted non-enrolment but not discontinuation after starting.

Study at a glance

Abstract

Objectives: Mindfulness-integrated Cognitive Behavior Therapy (MiCBT) is an evidence-based, structured, transdiagnostic program. This study investigated three interrelated questions: (a) which characteristics predict initial enrolment suitability following intake assessment. (b) which baseline characteristics predict clinical improvement during MiCBT, (c) which characteristics predict treatment retention.Method: Participants were 326 adults (195 male; Mage = 41.4, SD = 14.0) assessed at two psychology clinics. Of 326 assessed at intake (baseline), 190 engaged in MiCBT (pre-treatment). Mixed-effects growth models, Elastic Net, logistic regression, and XGBoost estimated enrolment and treatment outcomes, while Cox regression, Random Survival Forests, and Accelerated Failure Time estimated retention.Results: Large treatment effects were observed (Stress d = 1.47, Equanimity d = 1.71). More severe Depression and PTSD diagnoses moderated faster distress reduction, while PTSD and ADHD predicted greater life satisfaction gains. Equanimity improvement was strongly correlated with distress reduction (r = –0.47) and life satisfaction gains (r = 0.39). For retention, younger age (HR = 0.81, p = 0.027), lower life satisfaction at baseline (HR = 0.83, p = 0.041), and personality disorder diagnosis (HR = 1.84, p = 0.042) were significant predictors. Critically, prior meditation experience predicted higher likelihood of enrolment (χ² = 9.44, p = 0.002) but not subsequent retention (p = 0.885), while diagnosis of ADHD predicted non-enrolment (χ² = 6.69, p = 0.010) but not discontinuation among those who had commenced.